Wednesday, June 22, 2022

How To Negotiate Dental Provider Insurance Fees

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Tips For Dental Ppo Fee Negotiation And Credentialing

How to Negotiate Insurance Fees with Sandi Hudson from Unlock The PPO

You may think you do not have the time to get credentialed or negotiate fees with new dental insurance plans, but the effort may be worth it for the increased profitability and growth of your practice. Here are some tips to help you consider and optimize the opportunity.

There are many things to consider when deciding to go in-network with a dental insurance plan. And there are ways dental practices can optimize PPO credentialing and negotiating to increase the benefits of their network participation. The following tips apply to general dentists and specialists in private practice, group practice, or a dental service organization .

Data Sources And Sample

To understand how dental and insurer concentrations affect the prices of dental services in 2016 and 2017, we construct a county-level dataset from three proprietary databases merged with demographic information from the Area Health Resource File , cost of living data from the Council for Community and Economic Research, and data from the US Census. The first proprietary dataset is the IBM Watson MarketScanĀ® commercial dental claims database. This database is a convenience sample of commercial dental insurers that includes data from large employers and health plans in the United States. It is estimated that IBM Watson captures approximately 7.6 percent of the commercial dental insurance market. MarketScanĀ® includes claims from a variety of fee-for-service , preferred provider organization , and capitated health plans. To assure compliance with HIPPA, we were able to obtain average gross payments for commercially insured patients at the county level for 23 common dental procedures for counties in which at least 30 claims for the procedure were billed. We verified with dentists at the American Dental Association that these 23 common dental procedures are commonly performed by general dentists.

Negotiating Fees With Insurance Companies

As Im sure you are aware, you can negotiate your Insurance PPO fees every 2 years with dental insurance companies such as Aetna, Ameritas, Assurant, Cigna, Blue Cross, Carrington, Dentemax, Guardian, Humana, Principal, United Healthcare, and Metlife.

Step 1: Organize your PPO plans that you are currently contracted with and check the date you joined.

Step 2: Identify your TOP 25 most utilized/billed procedures codes.

Step 3: Contact your local Network Recruiter for EACH PPO plan. You will want to use key leverage items based on your Location, Specialty, Availability and Why You? Use information about what you do for the community and why they want you in their network. Ask them to review your fees and ask for an increase. They are there to help you.

According to our negotiating experts, if these instructions are followed this will help pave the way for us to speed up negotiations with other insurance carriers in the future.

Please email Julie at if you are interested in more information on how Washington State Dentists are using leverage to negotiate.


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Ways To Negotiate Lower Doctor Bills

    Monkey Business/Thinkstock

    For the past couple of years, Ive been putting off getting a bone-density scan, despite my doctors urgings. I have made efforts to bolster my bones and havent broken any since my last scan six years ago, so I figured I didnt need a new test. And Ive been hesitant for another reason: Money.

    My doctor wanted me to get the scan done in his office, but hes not in my health insurers network, so it would’ve cost me $400. Not surprisingly, I decided to wait. But when a podiatrist recently said I had a stress fracture in my right foot, I knew it was time for another scan.

    How I Saved $200 on a Bone Scan

    After checking around, I learned I could get it done nearby for less. So I asked my doctor if hed reduce his price. He agreed pretty quickly, trimming $200 off the $400 fee, and I had the scan done in his office. Fortunately, my bone density had changed very little and it turned out I didnt have a stress fracture.

    This experience taught me a valuable lesson about health-care costs: Sometimes you can reduce your doctor and dentist bills simply by asking.

    Knowing how to negotiate medical costs can be especially useful this time of year since your annual deductibles have just started up again and youll be on the hook for out-of-pocket expenses until you cross the deductible thresholds.

    Why It Pays to Speak Up

    Reluctant to talk dollars and cents with someone in a white coat? Dont be, says Victoria Veltri, Connecticuts health care advocate.

    Check The Bill For Errors

    Insurance Fee Negotiating by Dental Insurance Fee ...

    This can be tricky because medical bills have their own unique language, but you can determine whether your bill is accurate if you know where to focus your attention.

    Virtually all procedures are coded to facilitate collections from insurance companies. You can do an online search to find the meaning of the medical codes that appear on your bills. You can compare the meanings with your procedures to find out whether you’re being billed for the treatment you actually received.

    Some errors are surprisingly commonplace:

    • Codes might be mismatched, which means they don’t line up with your diagnosis. If the codes don’t match, your insurer, if you have one, will most likely decline to pay any portion of this claim.
    • Upcoding involves a bill for treatment that might be similar to what you received, but it’s not the treatment you underwent, and it usually costs more.
    • Other errors can include numerous billings for the same procedure, known asduplicate billing.
    • And unbundling is when services that should have been billed under one umbrella diagnosis or code are broken out, often adding up to additional costs.

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    The 7 Steps To Negotiating Ppo Fees

    Have you wondered how to successfully negotiate fees with insurance companies? Participants will learn about “leasing arrangements” PPO’s have with each other and how that could impact fees for dental offices in both a positive and negative manner. While negotiations in every industry are different, this course will teach basic negotiating skills that are specific to dealing with dental insurance companies. Participants will leave this course having a better understanding of how insurance companies determine reimbursement rates and how they can negotiate better reimbursement terms from most dental plans.

    Your Dental Practice Should Negotiate Insurance Fees

    Why negotiate Insurance fees? Insurance companies pay different reimbursement fees to different dentists for the same services. Some dentists are paid as much as 10% more for their services. The difference in the amount dentists receive from insurance companies is based on the ability of the dentist to successfully negotiate insurance reimbursement fees that are at least a little higher than what they had received previously. Some dentists handle negotiations themselves. Others partner with companies that are experts at negotiations. Dentists had been able to simply ask the insurance company for a 5% annual increase and receive it. But those days are over. Today, PPO negotiation is the norm.

    The Growth of Preferred Provider Organization Plans

    One reason insurance companys no longer simply give dentists annual payment increases when they request it is because Preferred Provider Organization plans have grown in popularity. PPOs now account for more than 85% of the dental plans under which most dentists provide services. As more dentists work under in-network plans, the insurance companies feel less pressure to negotiate. As employers embrace the PPOs as a way to reduce the cost of providing medical and dental care for their employees and increase their bottom line, insurance companies are less willing to negotiate fee increases.

    Know Where You Stand

    How Many Insurance Companies are Involved?

    Negotiating Fee Increases Can Be Difficult

    Helping Dental Practices to Thrive

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    How Can I Find Dental Insurance That Covers Everything

    If youre a baby boomer, you may remember having dental insurance that was accepted by any dentist or dental care professional. You paid for the care you needed, out of pocket, and the insurance provider then reimbursed you for most of the costs. Your dentist was happy to work out a billing plan, so you didnt have to produce a large sum immediately to get care.

    If you want this type of dental insurance, search online for indemnity dental insurance. Its sometimes also called a fee-for-service plan, or traditional dental insurance. Independent insurance brokers sell it, the Obamacare marketplaces currently do not and are unlikely to do so.

    Indemnity insurance is as close as youre likely to come to getting dental insurance that covers everything. With indemnity dental insurance, you can visit any dentist there are no networks or approved providers. You pay a deductible on your indemnity dental insurance, after which the insurance provider will cover a part – typically between 50% and 80% of “reasonable and customary” dental costs, as well as 100% of your preventative care. So far, this is essentially the same deal as youd get with other dental insurance plans, but you will be able to see your own dentist assuming he or she accepts the plan, and most will.

    Metlife’s Preferred Provider Organization Plans Feature The Metlife

    Negotiate Your Low PPO Fees!

    Metlife is uofl’s dental provider. Insurance provider metlife enforces waiting periods for most of its policies, but these are waived for. This program includes a nationwide network of dentists who have agreed to reduce their fees below the average. However, if you visit a preferred network provider, you save money since providers in the network charge negotiated rates.

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    How Can That Be

    Most doctors have lived with the same PPO fees for years, even decades. If youre in this situation, youre not alone. Its not uncommon but its frustrating and painful for doctors whove been wondering how others manage to create better profits on the same procedures.

    The reality is that dental fee schedule negotiation has created an unfair advantage for many practices.

    The good news about this reality is that you can be one of them!

    Dental fee schedule negotiation is especially important when youre considering when and where to open a new office.

    The ideal location for your new office will be influenced heavily by this topic if you do it right. Doctors in the know will have a much better chance at commanding higher reimbursements. And below, well show some examples where dental fee schedule negotiation works.

    Note: Weve created a powerful 5 Part Step-By-Step process in this . you can view it in the Bonus Section.

    Dont believe me? If its true, would it make your blood boil, knowing that you could have been paid more over the years?

    How To Negotiate Fee Increases With Insurance Companies

    Physicians are often unaware they can consider negotiating reimbursement rates with insurance companies. After all, health care providers and their networks play an important role in the insurance business. There may be times reviewing your existing contract helps, such as when there are changes or updates to CPT, diagnostic, and behavioral health billing codes.

    In doing so, you could find opportunities to renegotiate a contract with an insurance provider. Depending on the practice, the reimbursement rates may differ, even for similar types of treatments and services. This can result in being reimbursed less than other practices, which negotiated their original contract differently. A thorough review can also reveal outdated codes that are no longer accepted and which should be updated.

    If youre not satisfied with your insurance providers reimbursement fees, these tips for negotiating rates with insurance companies can help:

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    Have You Ever Renegotiated Your Payor Contract & Fee Schedules

    Have you ever wondered if renegotiating contracts is really worth the time and effort?

    Is an increase in payment even possible? Will payers consider changing your contracted rates?

    According to The American Medical Association, doctors are working harder and earning less. So much of what physicians face in their budgetary shortfalls is directly related to the reimbursements they receive from major insurance companies. When the government issued a sequester in 2012, all Medicare physicians received a 2% pay cut. Now physicians who have not been able to meet the mandated Meaningful Use requirements face an additional 2-4% pay cut. All of this piled onto declining contractual insurance reimbursement rates has led some physicians to see so many patients to make ends meet that they are no longer capable of really providing the excellent care and oversight that their patients deserve.

    Are you ready to take charge of your practice?

    Are you ready to turn your bottom line green again?

    Fee Schedule & Contract Renegotiation

    When was the last time you were given a raise? I can almost certainly say its probably been a while. Not pursuing a raise in your contracted fee schedules from your contracted payors is detrimental to your practices bottom line.

    There are at least twenty steps to take in this process and what are some of those steps?

  • Step 3: You must determine the gross collection ratio for each contracted payer.
  • Expertise Matters

    Take Back Control From The Dental Ppos

    Cost comparison of dental insurance to other everyday ...

    Thinking of dropping Delta Dental?

    Thinking of cutting back on dental PPO participation?

    Tired of writing off tens of thousands every month to dental PPOs?

    Want to Lose the Discounts and Keep the Patients?

    The right plays with PPOs can have a substantial impact on your bottom line. No one has more experience with PPO plays than Bill Rossi and his team at Advanced Practice Management. If you are considering joining, dropping, or negotiating with a PPO, call us.

    No contracts, no hype, just straightforward advice. We have helped scores of clients increase their collections by tens of thousands per month. Find out the right dental PPO play for you!

    Negotiations – Decisions – Transitions

    Bill Rossi is the countrys leading expert on PPO decisions and transitions. PPO decisions must be made in the context of the practices realities. Bill has over 35 years experience in advising dental practices. For the past 20 years has helped many dentists successfully cut back on their PPO participation to enhance their bottom line and practice independence.

    Zoomcast: Boost your DentistryIQ: Should you drop PPOs?

    Zoomcast: Boost your DentistryIQ: Youve dropped PPOs. Now what?

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    Metlife Dental Negotiated Fees 2021

    August 21, 2021Metlife DentalComments Off on Metlife Dental Negotiated Fees 20212 Views

    Metlife Dental Negotiated Fees 2021. Another option is getting a dental discount plan rather than an insurance plan. Metlife is one of the largest providers of insurance, annuities, and employee benefit programs.

    Metlife dental insurance is the parent company of the metropolitan life insurance company, or metlife dental insurance, and its subsidiaries. Option one is a ppo plan where services are based on a percentage of the metlife pdp negotiated fee for participating providers. Another option is getting a dental discount plan rather than an insurance plan.

    Do You Negotiate Ppo Fees

    You most likely already have a lot going on in your dental practice. You are managing patients, staff, and the day-to-day tasks that keep things running smoothly. It may seem easier to skip PPO fee negotiations. If you want your practice to grow and be successful, then you need to have a say in your reimbursement amounts.

    Are You Credentialed?

    Credentialing is a process used to vet dental practices. The facilitys history and the dentists qualifications are evaluated before the location can be added to networks used by insurance companies.

    The negotiation process requires time and money. That is why it is best to look for networks that are likely to give you the highest number of new patients. Research companies that cover your areas biggest employers. This will also give you more power when discussing fees.

    What Does It Take to Negotiate PPO Fees?

    If you are waiting for the insurance company to contact you to negotiate your fees, then you may be waiting a long time. Insurance providers are a business, and it is their goal to pay the lowest fees possible. You will most likely have to reach out to your contacts within the company to begin negotiations. Keep in mind that you will have to be persistent.

    You should not take the first fees offered to you when it is time to negotiate. Always push for better reimbursement. You may not want to accept the second or third round, either.

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    Negotiated Rates Are Confidential

    Health insurance companies negotiate the rates in which they will reimburse to providers for health care services rendered to their members. The negotiated rates in the contract between the health insurance company and the provider are secret and confidential. Until you receive an invoice for the service from the doctor, hospital, or lab, neither the health plan nor the provider can reveal that actual reimbursement rate. While most health insurance companies now have health care cost estimators, many people have indicated that the estimated cost range is too large to be of any use or just plain wrong when they contact the provider.

    Before You Have A Medical Or Dental Service: Know What You Will Owe

    Delta Dental and Co-Pay Fee Schedules with Open Dental

    Step 1: Talk to the healthcare provider you intend to seeor the providers office staff–to ask about the service or procedure that you will receive, its billing code and price.

    • If you have insurance, find out which doctors and hospitals are in your plans network. You usually will pay less for services performed by in-network providers than for those performed by providers outside the network.
    • If you do not have insurance or need to go to an out-of-network provider, contact the offices of providers you are considering. Ask about the name of your service or procedure and whether other services may be included. You also should ask for the code associated with each service.
    • Ask how much the provider would charge for each service or procedure you need to receive.
    • Record the names of the people you spoke to and all codes and prices you discussed. Ask them to send you this information in writing or by e-mail, if possible.

    Step 2: If you have insurance, find out if your insurer will cover any of the costs of your out-of-network service or procedure.

    Step 3: Use this website to estimate the cost of your medical or dental service and compare it to what your provider is charging.

    Step 5: If you have a flexible spending plan, use it. With a flexible spending plan, you can save by using pre-tax dollars to pay for healthcare services. For more information, see Flexible Spending Plans.

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